J.Jpn. Surg. Soc.. 88(3): 266-272, 1981

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Original article

NEURONAL AND ADRENOMEDULLARY CATECHOLAMINE RESPONSE TO CARDIOPULMONARY BYPASS : A SPECIAL REFERENCE TO COMPARATIVE STUDIES ACCORDING TO FUNCTIONAL CLASSIFICATION

Plasma epinephrine (E) and norepinephrine (NE) levels during cardiopulmonary bypass (CPB) were studied in thirty-eight cardiac patients with various grades of NYHA classification. Striking increases of both E and NE levels after release of aortic cross clamp (stage 4) were noted. A thirteenfold increase in E (from 0.05±0.05ng/ml to 0.62±0.48ng/ml) and sixfold increase in NE (from 0.21±0.18ng/ml to 1.26±0.78ng/ml) occurred from prebypass (stage 1) to stage 4. The values of E and NE were peaked at stage 4 and rapidly decreased after heart beating (stage 5). At chest closure (stage 7), E returned to close to prebypass control (stage 1) value, however NE remained still in moderately high level.
Patients were divided into three groups : The mild group (NYHA class I and II, fourteen patients), the illed group (NYHA class III and IV, nineteen patients) and the IABP group (IABP support since prior to CPB due to unstable angina and ventricular septal perforation, five patients). Whereas E value at either stage 4 or stage 5 in the mild group was statistically significantly higher (p＜0.05) than each E value at corresponding stages in the illed group. NE value at each stage 3 (prior to aortic cross clamp), stage 4 or stage 5 in illed group significantly higher than each NE value at same stages in the mild group respectively. These data suggest that depletion of E and compensatory increase of NE in the illed group may be occurred during CPB. In IABP group, E values during CPB kept throughout in low level, and NEchange was shown low level from stage 1 to stage 4 following relatively high level after stage 5 to stage 7, without showing peaked top of stage 4 in both E and NE. Depletion of E and compensatory and/or delayed increase of NE are also conjectured in this severe patient group.

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